Autoperipheral blood mononuclear cell transplantation improved giant ulcers due to chronic arteriosclerosis obliterans

Abstract

We report the case of a 74-year-old man with Fontaine stage IV chronic arteriosclerosis obliterans who had been suffering from inveterate giant skin ulcers on the dorsum and heel of the right foot. As conventional medical treatments had not improved these ulcers and surgical treatment was considered unfeasible, amputation of the right lower limb below the knee appeared to represent the only option. The patient was admitted to Tottori University Hospital to attempt a new angiogenic therapy using auto-mononuclear cell transplantation to avoid amputation. On admission, neither right ankle blood pressure nor transcutaneous partial pressure of oxygen at the right toe were detectable. The patient had a history of multiple cerebral infarctions, and collection of mononuclear cells from bone marrow was considered too difficult, so collection of peripheral blood mononuclear cells was selected. Transcutaneous partial pressure of oxygen and skin temperature in the treated limb started to improve from 2 weeks after implantation. Ulcer size was recognizably reduced by 1 month after treatment. Partial auto-skin implantation on the right heel was performed 2 months after treatment, and the giant skin ulcer was finally completely covered. No adverse effects were noted during follow-up lasting 1 year. These results suggest that peripheral blood mononuclear cell implantation may offer a suitable alternative rescue therapy for patients with critical limb ischemia whose general condition is not good.

Takayasu Arteritis and Ulcerative Cutaneous Sarcoidosis

“…Patients with necrobiosis lipoidica exhibit infiltration of lymphoplasma cells surrounding the blood vessels, possibly associated with wall thickening; however, these findings were not observed in the current case (19). Arteriosclerosis obliterans, a cutaneous ulcer, may also develop, although these lesions may initially form on the heel or the top of toe in the lower extremities (20,21). Such lesions were, again, absent in the current case.…”

Progenitor Cell Therapy in Patients With Critical Limb Ischemia Without Surgical Options

“…One report shows a beneficial effect of intramuscular administration of G-CSF-mobilized CD34 ϩ cells in 2 patients, 46 1of G-CSF-mobilized CD133 ϩ cells in 1 patient, 47 and 1 study shows beneficial effects of PB-MNC treatment without G-CSF mobilization. 48 By far the most studies of progenitor cell therapy for CLI have used intramuscular implantation methods. In 1 uncontrolled study in 7 patients, administration of G-CSFmobilized autologous PB-derived progenitor cells was performed by intra-arterial injection.…”

Cell Therapy of Critical Limb Ischemia (Problems and Prospects)

“…Эти результаты сохранялись не менее 6 мес. Осложнений после имплантации клеток зарегистрировано не было [88,89]. К настоящему времени опубликовано более 120 работ, посвященных применению клеточной те-рапии при заболеваниях периферических артерий, из них более 30 контролируемых клинических исследо-ваний закончены [57,90,91].…”

“…В частности, применение мо-нонуклеарной фракции клеток периферической крови пациента не приводило к достоверному улучшению за-живления язв на ишемизированной конечности [89], а введение только гемопоэтических СК с фенотипом CD34 + , выделенных из мононуклеарной фракции клеток аутологичного костного мозга, не улучшало эффективно-сти клеточной терапии КИНК [97].…”